Stroke Flashcards
aims of stroke management
- is the disability reversible with treatment? ie timeframe
- rehabilitation - how to help patient back to living their life
- how to prevent next stroke?
thrombolysis
<4.5hr
thrombolysis timeframe
what is used?
<4.5hr
recombinant tPA / alteplase
ischaemic stroke management
thrombolysis
thrombectomy
neuro plasticity
brain tissue surrounding damaged brain re learns how to perform certain action
stroke is a clinical diagnosis, true or false
true
3 hallmarks of stroke
- acute onset - when did it start?
- focal neurological deficit
- disrupted blood flow / vascular cause: ischaemia vs haemorrhage
D.Dx of stroke ie stroke mimics
Bells palsy Migraine Todd's paresis (post-ictal) Hypoglycaemia acute on chronic: brain tumour, MS, bleeding Functional - non consistent symptoms
how to differentiate between types of stroke
non-contrast CT head
which is more common, ischaemic or haemorrhagic stroke
ischaemic
risk of having a second event is extremely high immediately after the first event, true or false
true
intracranial haemorrhages are not all stroke, true or false
true
can get extra/subdural/subarachnoid haemorrhages which is not the same as a stroke
describe the bleeding in a haemorrhagic stroke
intracerebral haemorrhage causing compression
neurosurgery will reverse haemorrhagic stroke, true or false
false
not usually involved unless life threatening
it will still not reverse the disability
haemorrhagic stroke is the same as intracerebral haemorrhage
yes
causes of haemorrhagic stroke
anticoagulants perpetuate blood loss hypertension arteriosclerosis amyloid angiopathy vasculitis - any layer of vessel wall AVM aneurysms (more likely to be SAH) extravascular causes: - bleeding into tumour - abscess
arteriosclerosis vs atherosclerosis
arteriosclerosis - not intimal disease, disease of tunica media muscle layer, calcification leads to hardening of artery like a tendon, can snap and bleed
not necessarily a HTN disease, more ageing
atherosclerosis - intimal disease with plaque deposition and cholesterol
types of intracerebral haemorrhages
peripheral /lobar haemorrhage
deep haemorrhage - more likely to be secondary to HTN
which carotid artery is concerned with the brain
ICA
where do the vertebral arteries arise from
subclavian arteries
where is the circle of willis found
CSF / subarachnoid
importance of circle of willis
collateral circulation to brain
large vessel occlusion almost always ischaemic
embolic
do it again
looks for source of embolus
ECG, scan…
what is affected in lacunar stroke
small infarcts from perforating arteries
thrombus
TIA
autothrombolyse
large vessel occlusion
cortical involvement
small vessel infsarcts
deep
how to differentiate between large and small vessel infarct
cortical involvement
large - cortical involvement
cortical signs
functions served by cerebral cortex
dominance
right vs left
deals with communication